Corticosteroids (Steroids) Such as Prednisone Given During an Acute Viral Infection May Cause ME/CFS

Dr John Chia has noted that corticosteroids given during an acute viral infection seems to be a recipe for precipitating ME/CFS.

That is to say: acute infection + corticosteroids = ME/CFS

In this presentation by Dr John Chia (found on the DVD of the Invest in ME International ME/CFS Conference, London 2010), Chia talks about the factors and events his ME/CFS patients report just prior to them developing ME/CFS.

One factor that Chia says he hears of hundreds of times, occurring just prior to the onset of ME/CFS, is that the patient was given corticosteroids (steroids) such as prednisone or prednisolone at a time when the patient was acutely ill with a viral infection.

From hearing this story time and time again from his ME/CFS patients, Chia thinks that taking steroids while fighting an acute enterovirus infection is a recipe for disaster, as it seems to precipitate ME/CFS.

Why might corticosteroids be given for a viral infection? If you watch this part of the video, Dr Chia says the skin rash that may be caused by an acute enterovirus infection can look like chicken pox, measles, German measles, or hives.

Dr Chia says that if, for example, people suddenly become ill and develop a skin rash from an acute enterovirus infection, they may go to the emergency room, and the emergency room doctor will look at the rash, and might suspect the rash to be hives, since enterovirus rashes can look identical to hives.

So the ER doctor will question the patient as to what he ate beforehand. If the patient just happened to eat some shellfish, then the ER doctor may assume that the patient's rash is indeed a hives rash, caused by allergy to the shellfish, and so will put the patient on a course of steroids, like prednisone or prednisolone, as this is the normal treatment for hives.

So the patient has a fierce acute enterovirus infection, and needs a strong and robust immune response to fight off this infection, yet receives immunosuppressing corticosteroids, because the rash was diagnosed as hives, which is a disaster.

Similarly, if a patient came down with an acute viral infection, and its symptoms were suggestive of asthma, they may also get corticosteroids, because that's how you treat asthma.

Dr Chia says on the video:

"If the patient already had chickenpox before and they then develop flu-like illness with chickenpox-like rashes that's enterovirus until proven otherwise. But the rash could look like measles, German measles, it could look like hives. So very often people travel, eat some shellfish, and develop this hives, all over. Went to the emergency room, the emergency room doctor will say, "Oh Well, you ate lobster, you must be allergic to shellfish. " So what's the next thing they get? They get some prednisone, steroids, and that disease never ended. They develop chronic fatigue syndrome after that. We hear this hundreds of times."

"Glucocorticoids: if the patient developed a viral infection, and with symptoms suggestive of asthma, they are often given steroids, because it's the mainstay of therapy. That can shift the immune response to Th2, not to mention you'll drop the T-lymphocytes down to practically zero."

Source: timecodes 07:31 and 28:00, Dr Chia presentation, found in the DVD set of the Invest in ME International ME/CFS Conference, London 2010.

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So it appears that if you take immune suppressing drugs like corticosteroids at a very critical stage when the body is trying to fight off a fierce acute enterovirus infection, one presumes that these steroids may weaken the immune response to such a degree that the enterovirus is now able to get a much better foothold in the body tissues — ie, the virus may penetrate deeper into the body, penetrate into more tissue compartments of the body — and so this enterovirus infection is never eradicated, and it becomes a chronic, persistent infection, and the patient may then come down with ME/CFS a few weeks or months after.

Dr Chia says on another video:

"We give steroids like it is holy water. Steroids put out the fire very quickly. The patients feel wonderful — for a few days. Then a few weeks to months later, they come down with this dreaded disease. [ie, ME/CFS] We physicians sometimes don't realize what harm we have done. I tell every doctor now, you don't give steroids unless the patient's life depends on it."

Source: timecode 23:40, Dr Chia presentation, found in the DVD set of the Invest in ME International ME/CFS Conference, London 2011.

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So acute infection + corticosteroids = ME/CFS may explain the reason that a subset of patients developed chronic fatigue syndrome.

EDIT: unfortunately that Dr Chia video presentation linked to above had to be taken down from YouTube, because Invest in ME claimed a copyright infringement. This 45 minute Dr Chia video can be bought from Invest in ME. It comes on the following DVD set: Invest in ME International ME/CFS Conference, London 2010. (Though all the relevant information from that Chia video, about corticosteroids precipitating ME/CFS, has been transcribed in the quotes given above in this post).

First, at the gene cluster level, our study shows a bidirectional action of GC, which are both immunostimulatory and immunosuppressive at the same time even for the inflammation cluster (12)⇓. They seemed to prime and enhance the innate immune response while repressing part of the adaptive immune response in a resting state.

First, at the gene cluster level, our study shows a bidirectional action of GC, which are both immunostimulatory and immunosuppressive at the same time even for the inflammation cluster (12)⇓. They seemed to prime and enhance the innate immune response while repressing part of the adaptive immune response in a resting state.

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Yes, i have been reading up on this of late and GC steroids increase neutrophil counts, this would help certain infections. Maybe it depends on the dose and the duration of treatment, maybe its the very high doses that is the issue. I think about 5mg of prednisone is equal to what our bodies make where when docs give prednisone its usually a much higher dose.

It might not be related to this but i found interesting was that TNF alpha actually block cortisol receptor sites, this might explain how tnf is inflammatory as its blocking the bodies anti inflammatory mechanisms cortisol. Cortisol seems to be involved in alot of processes.

@Valentijn
I guess that prednisone may have possibly been a factor in your development of ME/CFS, though Dr Chia mentions a timescale of a few weeks to a few months for ME/CFS to appear after prednisone was given during the acute phase of a suspected enterovirus infection.

I think this corticosteroid etiology for ME/CFS that Dr Chia has observed may be quite similar to mold etiologies: if you are exposed to mold, this can suppress your antiviral Th1 immune response,† so if you were unfortunate enough to catch a ME/CFS-associated virus at the same time that you were exposed to mold, this virus will encounter a weakened immune system, and so again, the virus may be able to penetrate deeper into the body, and penetrate into more tissue compartments of the body, thus becoming a chronic, persistent infection that cannot be eradicated.

So if you take an overview perspective of both the corticosteroid and mold etiologies, they point to this idea that ME/CFS is caused when an acute viral infection meets a temporarily weakened immune system, so that during the acute infection period, the virus is able to insinuate itself deeper into the body, creating a chronic infection, and then precipitating ME/CFS.

If this idea is correct, then it could explain why some people develop ME/CFS from virus in circulation, but other people who catch the same virus do not: it just comes down to the fact that those who developed ME/CFS had some external factor such as corticosteroids or mold exposure that made their immune system weak at the moment the virus hit them.

I never thought about it, but now that you mention this, I remember having a really bad tendinitis in my knee and heel, five years ago. It was consequence of overtraining without proper warming before. When i went to the doctor he inyected me something to help with the inflammation, I'm not sure what it was, but now I'm suspecting it could have been corticoids. At that moment I didn't care because the pain was so terrible that the only thing i wanted is relief.

It took me a couple of months to recover totally from the tendinitis. Then, three years ago, i fell sick with a giardiasis that affected not only me but to all my co workers for drinking contaminated water in the office. i received treatment and I recovered very fast from it, but now I wonder if these situations could have played a part in me getting this illness two years ago.

every so often I read on a forum of an asthma cure like spirulina and azithromycin, but I can't exhale after taking 6 weeks of azithromycin
I've been on a lot of short/medium courses of prednisone for asthma and take symbicort regularly, does it damage your energy and adrenals? all my doctors are kind of conservative about prednisone and it can destroy your bones.

Quite interesting but I'm not sure I buy it. It's easy to say everyone gets CFS from corticosteroids but everyone basically is prescribed them nowadays at various times for various things. It's like saying oxygen causes CFS. lol

If all of these viral stories were true then someone would have been cured by now with an anti viral. You hear tons of people saying they got temporary relief from one but that means nothing.

Quite interesting but I'm not sure I buy it. It's easy to say everyone gets CFS from corticosteroids but everyone basically is prescribed them nowadays at various times for various things. It's like saying oxygen causes CFS. lol

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Nobody is saying that ME/CFS arises purely from corticosteroids, but rather that if corticosteroids are given precisely at the time you happen to come down with an acute enterovirus infection, then this may lead to ME/CFS.

If all of these viral stories were true then someone would have been cured by now with an anti viral. You hear tons of people saying they got temporary relief from one but that means nothing.

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People have been put into near remission from ME/CFS for periods of 2 to 14 months by taking very potent antiviral treatments that target enteroviruses. If you look at the research done by Dr Chia using interferon treatment, you see that he was able to put ME/CFS into near remission for months. Unfortunately, after several months, the virus would slowly reinstate itself in the body, and the ME/CFS would return.

I know this is an old thread but I'm new to the forum and this topic isVERY relevant to my current situation.
I've had ME for 14 years. I'm currently 10 months into steroid withdrawal(aka tsw). The condition is not yet recognised in the uk . If anyone is currently using steroids, particularly topical steroids I would urge you to check out itsan or the many videos on YouTube. What has brought me back to the ME community is that I now believe steroids( nebuliser and inhaler) could indeed have majorly contributed to my onset of ME. I was prescribed oral steroids last year with disastrous results.